Fig 2 - uploaded by Henri Colt
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A: A diagram showing stents positioning in the airway. The cuff-link-shaped DJ fistula stent is attached to the distal extremity of the right bronchial limb of the customized Y stent. B: Chest radiograph obtained at the time of rigid bronchoscopy showing the right hydropneumothorax with fluid level present in the infrahilar region. C: Chest radiograph obtained 3 months postintervention shows an increase in the fluid level now seen at the level of pulmonary hilum.
Source publication
Large postpneumonectomy stump fistulas pose a significant problem for thoracic surgeons and interventional bronchoscopists. We present a case of successful rigid bronchoscopic repair of a complete right pneumonectomy stump dehiscence using a custom-built stent made of a sculpted silicone Y stent sutured to a new cuff-link-shaped DJ-Fistula stent. T...
Contexts in source publication
Context 1
... limb cuff- link-shaped stent into position within the stump, completely occluding the fistulous track (Fig. 1D). Surgi- cel was then applied distally onto the stump surface lateral to the stent, and fibrin glue was deposited onto the surgicel to prevent micro leaks. A diagram of the stents and their positioning in the airway is illustrated in Fig. 2A. The patient was then extubated, and a #8 Shiley tra- cheotomy tube was inserted. The distal aspect of the tube was positioned so that it was 2 cm above the proximal aspect of the tracheal limb of the Y stent. The patient was then connected to the ventilator and moved to the medical intensive care ...
Context 2
... large bore chest tube was removed one week later. The patient was weaned from mechanical ventilation and a Passy-Muir speaking valve was placed on the tracheostomy tube. The patient was discharged 4 weeks after stent insertion. A chest radiograph obtained three months after the procedure showed improvement in the right-sided hydropneumo- thorax (Figs. 2B and 2C). The tracheostomy tube was subsequently removed, and one year later the patient is at home and continues to do ...
Citations
... Silicone stents have also been placed using rigid bronchoscopy for the management of large postpneumonectomy BPF. For instance, a customized Y-shaped silicone stent successfully occluded a left mainstem bronchus stump dehiscence after trimming the corresponding bronchial limb, pushing a cuff link-shaped prosthesis (DJ-FistulaTM, Bryan Corp., Woburn, MA) into the stent's distal lumen, and suturing it with silk (77). Additionally, the stent was reinforced with Surgicel ® and fibrin glue to prevent any residual leaks. ...
Bronchopleural fistula (BPF) with prolonged air leak (PAL) is most often, though not always, a sequela of lung resection. When this complication occurs post-operatively, it is associated with substantial morbidity and mortality. Surgical closure of the defect is considered the definitive approach to controlling the source of the leak, but many patients with this condition are suboptimal operative candidates. Therefore there has been active interest for decades in the development of effective endoscopic management options. Successful use of numerous bronchoscopic techniques has been reported in the literature largely in the form of retrospective series and, at best, small prospective trials. In general, these modalities fall into one of two broad categories: implantation of a device or administration of a chemical agent. Closure rates are high in published reports, but the studies are limited by their small size and multiple sources of bias. The endoscopic procedure currently undergoing the most systematic investigation is the placement of endobronchial valves. The aim of this review is to present a concise discussion on the subject of PAL and summarize the described bronchoscopic approaches to its management.
... The use of a modified Dumon Y stent with glue apposition permitted closure of a postpneumonectomy fistula without requiring additional surgical repair in a single case [22]. Recently, Colt and Murgu [23] presented a case where a custom-built stent made of a sculpted silicone Y stent sutured to a new cuff-link-shaped DJ-Fistula stent through rigid bronchoscopic resulted in repair of a complete right pneumonectomy stump dehiscence. ...
Stump dehiscence after pneumonectomy is a cause of morbidity and mortality in patients treated for non-small-cell lung carcinoma. Surgical repair remains the treatment of choice but can be postponed or contraindicated. Bronchoscopic techniques may be an option with curative intent or as a bridge towards definitive surgery. The aim of the study is to evaluate the efficacy and the outcome of a new customised covered conical self-expandable metallic stent in the management of large bronchopleural fistulas complicating pneumonectomies.
A case series using chart review of non-operable patients presenting with large bronchopleural fistulas (>6mm) post-pneumonectomies as a definitive treatment with curative intent for non-small-cell lung carcinomas and requiring the use of a dedicated conical shaped stent in two tertiary referral centres.
Seven patients presenting large post-pneumonectomy fistulas (between 6 and 12 mm) were included. Cessation of the air leak and clinical improvement was achieved in all the patients after stent placement. Stent-related complications (two migrations and one stent rupture) were successfully managed using bronchoscopic techniques in two patients and surgery in one. Mortality, mainly related to overwhelming sepsis, was 57%. Delayed definitive surgery was achieved successfully in three patients (43%).
This case series assesses the short-term clinical efficacy of a new customised covered conical self-expandable metallic stent in the multidisciplinary management of large bronchopleural fistulas complicating pneumonectomies in patients deemed non-operable. Long-term benefits are jeopardised by infectious complications.
